3.3.1 Safeguarding the quality in daily care
All nurse leaders stressed their responsibility for safeguarding the quality of care around the clock, including planning,
coordinating and controlling the daily care. Some leaders had delegated the daily control and supervision of the nursing
personnel to another nurse on the ward, but despite this they stressed their overall responsibility for the nursing quality.
Being present in the ward was seen as important, as this made it possible to get to know the patients and the personnel, and
sense the atmosphere in the ward. By observing the staff’s attitudes, behavior, skills and working performance, mistakes
could directly be adjusted by means of feedback and supervision.
‘I come a little earlier in the morning to talk to the staff before they start their work in order to know what is
happening…and I do a little round in the afternoon to see… I am not happy unless everything is ok ……’
(Informant nr 12)
To safeguard an adequate number of personnel with relevant competence on every shift was mentioned as one of the most
important and demanding tasks by most of the leaders. In the Swedish community care a lot of time was used to delegate
nursing tasks to licensed practical nurses and nurse assistants. Especially in community care, but also in hospitals, when
competent personnel were lacking some leaders could work ‘hands on’ in bedside nursing to ensure good quality of the
care. This further increased the leaders’ workload which was stressed as heavy from before.
The nurse leaders in the hospitals and in the Norwegian community care claimed that new administrative tasks had been
imposed on them during recent years, most often without preparation in advance. These new tasks hindered them from
being present in the daily care. Many administrative tasks were considered as more appropriate to be carried out by others
than nurses.
‘There are many more administrative and economic tasks than before … I think it is about 70 to 80%, but maybe
it is more … ’(Informant nr 11)
Administrative support could sometimes be provided from the department of human resources, but this support was
described as insufficient.